Provision of Emergency Medical Care in the Field

The conditions that EMTs worked under to provide medical care in the field were very poor. Debris in the street, burned out cars, downed telephone and power lines, smoke, and lack of lighting often made it difficult to get to the scene. EMSA's survey found that about 78% of the time EMTs reported that problems like the following "frequently" or "often" made it difficult to deliver care at the scene: rioters and looters surrounding the injured person and intimidated the responder; gun fire being directed over the EMTs heads or at them, or guns being brandished; people continuing to riot while efforts were made to treat the injured; responders being cursed, given the finger, and yelled at by angry, often drunken crowds; cars driven by the scene and their occupants threatening the responder; police pressuring EMTs to move faster; and friends and relatives of the injured getting in the way. All of this caused some EMTs to fear the public and to be concerned about their own life. Not all dispatches resulted in a transport as shown by the following data. EMTs reported that: 18% of the time they couldn't get to the casualty because of rioters; 17% of the time it was a dry run (couldn't find casualty or no casualty); 29% of the time the injured were cared for on site and released; 36% of the dispatches resulted in someone being transported to the hospital. About 64% of the time, care was provided at the scene that could have been given by someone trained in first aid. Interestingly, first aid was provide about 15% of the time by citizens prior to the EMTs arrival at the scene. EMTs responding to the EMSA survey reported transporting 539 injured persons. The following Table 15 reports their injuries and symptoms. Additional transports were made for persons suffering from the following symptoms or pro emotional distress, heart related problems, hanging, alcohol related symptoms, flu, cut hand, swollen feet, seizures, cardiac arrest, shortness of breath, chest pain, and sprains. Also, there was a field birth in a blacked out area. Escorts had to hold flashlights to illuminate the scene. EMTs were asked, using their everyday experience as a standard, where and when they stabilized the patient. Table 16 presents the data. The data shows that in comparison to everyday practice, the injured were about 50% more likely to be loaded at the scene and quickly transported to the hospital, with stabilization taking place on the way. About 85% of the time a run involved a single patient. Even after a transport was begun, the EMT was not necessarily safe. For example, on at least one occasion family members who accompanied the injured were intoxicated and threatened the ambulance driver on the way to the hospital. EMTs reported that 47% of the time transports t6ok as long as they usually do to get to the hospital. About 33% took more time, and 20% less. Maneuvering around debris and rioters probably accounted for more time. Once the curfew was effective, it took less time (EMSA survey). LAEMSA data for April and May 1991 indicates that over 63,000 hours were lost countywide due to hospital emergency department closures, related service saturation, or diagnostic equipment failures. These diversions can necessitate significantly longer transport times (LEMSA, 1991). It is very difficult to determine how much civil disturbance transport times vary from typical transport times. With the exception of the Daniel Freeman Medical Center and Martin Luther Kind\Drew Medical Center, LAEMSA directed hospitals not to go on diversion status during the civil disturbance. However, 25 % of the EMTs reported they had to bypass an emergency department because of this problem. Apparently the minute to minute reality of patient flow tended to overloaded hospital emergency departments for brief periods of time causing EMTs to believe that they were diverting ambulances. This does not appear to have been a serious problem.

Medical Care for the Injured

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